Yoga Case study #2

Yoga Case study #2 – In which a thorough exam + 1 week revealed that what we thought was one problem was actually two.

Two weeks ago a 62 y/o woman I’ll call Jane came in with a new problem that she’d been having for the last 3 weeks which had caused her to stop her yoga practice.  Her R lower back had flared up for no apparent reason, and seemed to spread into the R hip region.  She told me that she’s felt these same symptoms before (about a year ago), At that time, she got some temporary relief with massage therapy.

My role as a physical therapist is to selectively stress and strain joints, muscles, and fascia to reveal where the pain is coming from, and then to design a treatment program that will aid in the recovery of full strength, mobility and function. For a spinal examination, we move the patient through a series of movements in all directions, and observe how symptoms change.

By the time we were half-way through Jane’s exam, her lower back pain had nearly abolished.  This happens sometimes when a movement in a particular direction relieves the pressure or tension that was causing the pain.  In Jane’s case, the pain got gradually less and less with the repetition of forward bending of the spine.

Jane was extremely surprised to discover this, because she had heard that forward bending was bad for lower back injuries, and had been advised to stop forward bending in her yoga practice.  While this is true in certain cases, I encouraged her to listen to her body, and begin using forward bends any time her pain started to return.

Interestingly though, as good as her back felt now, there was really no change in her hip symptoms.  We would have to address this at the next visit.

One week later at her next session, she reported significant improvement in the lower back, and could relieve her back pain any time it came on by doing her forward bending exercise.  However, she continued to suffer from the same R hip pain.

It was at this point that she told me that she had a malformed pelvis.  She then described that both she and her massage therapist attribute the hip pain to her pelvic and spinal asymmetry.

I’ve learned over the years (and research supports) that spinal and hip pain is no more prevalent in people with spinal and pelvic rotations than in people without rotations.  So I continued my assessment.

Testing revealed normal pain-free joint mobility which means that the joint and capsule are healthy tissues (and therefore not the cause of her hip pain).  The deficit turned out to be in her hip muscles.  There was significant pain and weakness in the R hip musculature in all directions.  Her hip symptoms were reproduced precisely by fatiguing these muscles, which leads us directly to her treatment.  We put her on a hip strengthening program that she will be able to do on her own, and I have no doubt she will be back to her usual practice in a few week’s time.

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